Prior Authorization & Benefit Verification Specialist

Jobtailor; New Providence (NJ); On-site; USD 45,000 - 60,000; Full time

Job summary

Jobtailor is seeking an experienced healthcare administrative professional to handle benefit verifications, authorizations, and EMR documentation for infusion therapy patients. The role requires strong communication, attention to detail, and proficiency with CPR+ and Caretend.

The ideal candidate has a high school diploma (Bachelor’s preferred), experience with payer portals, and the ability to manage multiple tasks in a fast-paced environment.

Qualifications

• High school diploma or equivalent.
• Bachelor's degree in healthcare field or business preferred.
• Excellent oral and written communication skills are required.
• Appropriate computer skills, including Microsoft Office Suite.
• CPR+ and/or Caretend experience is preferred.
• Strong work ethics with attention to detail and quality are required.
• Ability to identify and address problem accounts is required.
• Previous experience working with infusion therapy patients is highly desirable.
• Prior experience with prior authorizations, specialty medications, or third-party payers preferred.
• Familiarity with electronic medical records, payer portals, and data entry systems.
• Ability to handle multiple tasks in fast paced, challenging environment.
• Infusion or DME background is preferred.
• Clinical, medical office administrative, or related experience preferred.
• Ability to occasionally lift up to 35 pounds.

Responsibilities

• Perform benefit verification for insurance changes, therapy changes, and dose changes.
• Process new and reauthorizations under new insurance plans for insurance changes.
• Process new and reauthorizations for drug or dose changes under existing plans.
• Create EMR notes.
• Submit electronic faxes.
• Follow up on and log recertification documentation from physician offices via CPR+ or Caretend.
• Update payer information and binoculars in CPR/Caretend.
• Update existing orders to show the correct payer in CPR/Caretend.
• Perform monthly verifications.
• Communicate authorization requests assigned to payers in a timely manner with patients, physician offices, and the sales team.
• Manage internal email communication to and from other departments.
• Attend to urgent/same-day requests.
• Perform other duties as assigned.

Skills

Excellent communication

Attention to detail

Strong work ethic

Problem-solving ability

Multitasking ability

Education

High school diploma

Bachelor's degree in healthcare or business

Tools

Microsoft Office Suite

Caretend

CPR+

Job description

Jobtailor is seeking an experienced healthcare administrative professional to handle benefit verifications, authorizations, and EMR documentation for infusion therapy patients. The role requires strong communication, attention to detail, and proficiency with CPR+ and Caretend.

The ideal candidate has a high school diploma (Bachelor’s preferred), experience with payer portals, and the ability to manage multiple tasks in a fast-paced environment.